罗明华,陈玉善,王贺,关怀敏,解金红,邱承杰,宗永华,尚莎莎,王运蔚

• 1:河南中医药大学第一附属医院心脏中心/国家区域(中医)心血管诊疗中心

摘要(Abstract)：

目的 本研究旨在考察急性心肌梗死合并心原性休克患者直接经皮冠状动脉介入治疗（PPCI）术后预后不良的影响因素。方法 入选2015年1月至2019年12月期间，河南中医药大学第一附属医院胸痛中心收治急性心肌梗死合并心原性休克并且行PPCI的患者，收集其临床基线特征、冠状动脉造影及PPCI相关参数、器械辅助支持信息等。根据1年内随访生存与否，分为生存组与死亡组，比较两组各项因素。结果 共入选40例患者，其中生存组26例，死亡组14例。两组在基线资料、入院诊断、危险因素及合并症等方面差异均无统计学意义（均P>0.05）；生存组较死亡组有入院时心率较低、血压较高的趋势；生存组心肌酶显著低于死亡组（肌酸激酶峰值：496.00(198.25,2 830.00)U/L比3 040.00(405.75,5 626.53)U/L,P=0.003；肌酸激酶同工酶MB型峰值：52.65(31.75,219.50)U/L比306.00(27.25,489.63)U/L,P=0.006）；两组间在冠状动脉造影及PPCI相关指标方面比较，生存组较对照组有更高的完全血运重建率（53.85%比21.43%,P=0.048）；两组器械辅助支持方面比较，生存组较死亡组有更多的体外膜肺氧合（ECMO）联合主动脉内球囊反搏（IABP）支持的比例（38.46%比7.14%,P=0.034）。结论 急性心肌梗死合并心原性休克行PPCI的患者的预后与心肌酶水平、ECMO联合IABP支持以及完全血运重建有关。

关键词(KeyWords)： 急性心肌梗死;心原性休克;预后;直接经皮冠状动脉介入治疗;心肌酶;体外膜肺氧合;主动脉内球囊反搏

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（82274316）

作者(Author): 罗明华,陈玉善,王贺,关怀敏,解金红,邱承杰,宗永华,尚莎莎,王运蔚

参考文献(References)：

• [1]Sarma D,Jentzer JC.Cardiogenic shock:pathogenesis,classification,and management[J].Crit Care Clin,2024,40(1):37-56.DOI:10.1016/j.ccc.2023.05.001.
• [2]Kapur NK,Kanwar M,Sinha SS,et al.Criteria for defining stages of cardiogenic shock severity[J].J Am Coll Cardiol,2022,80(3):185-198.DOI:10.1016/j.jacc.2022.04.049.
• [3] Jentzer JC,P?ss J,Schaubroeck H,et al.Advances in the management of cardiogenic shock[J].Crit Care Med,2023,51(9):1222-1233.DOI:10.1097/CCM.0000000000005919.
• [4]Samsky MD,Morrow DA,Proudfoot AG,et al.Cardiogenic shock after acute myocardial infarction:a review[J].JAMA,2021,326(18):1840-1850.DOI:10.1001/jama.2021.18323.
• [5]Damluji AA,Bandeen-Roche K,Berkower C,et al.Percutaneous coronary intervention in older patients with STsegment elevation myocardial infarction and cardiogenic shock[J].J Am Coll Cardiol,2019,73(15):1890-1900.DOI:10.1016/j.jacc.2019.01.055.
• [6]Baran DA,Grines CL,Bailey S,et al.SCAI clinical expert consensus statement on the classification of cardiogenic shock:this document was endorsed by the American College of Cardiology(ACC),the American Heart Association(AHA),the Society of Critical Care Medicine(SCCM),and the Society of Thoracic Surgeons(STS)in April 2019[J].Catheter Cardiovasc Interv,2019,94(1):29-37,DOI:10.1002/ccd.28329.
• [7]Arnold JH,Perl L,Assali A,et al.The impact of sex on cardiogenic shock outcomes following ST elevation myocardial infarction[J].J Clin Med,2023,12(19):6259.DOI:10.3 390/jcm12196259.
• [8] Khullar N,Buckley AJ,O'Connor C,et al.Peak troponin T in STEMI:a predictor of all-cause mortality and left ventricular function[J].Open Heart,2022,9(1):e001863.DOI:10.1136/openhrt-2021-001863.
• [9]Faro DC,Laudani C,Agnello FG,et al.Complete percutaneous coronary revascularization in acute coronary syndromes with multivessel coronary disease:a systematic review[J].JACC Cardiovasc Interv,2023,16(19):2347-2364.DOI:10.1016/i.jcin.2023.07.043.
• [10]苏利芳,支伟,高恒波,等.探索影响体外膜肺氧合联合经皮冠状动脉介入治疗ST段抬高型心肌梗死合并心原性休克患者预后的因素[J].中国介入心脏病学杂志,2023,31(12):904-910.DOI:10.3969/j.issn.1004-8812.2023.12.003.
• [11]Murphy D,Firoozi S,Herzog CA,et al.Cardiac troponin,kidney function,heart failure and mortality after myocardial infarction in patients with and without kidney impairment[J].Am J Cardiol,2023,204:383-391.DOI:10,1016/j.amjcard.2023.07.106.
• [12]Mohammad MA,Koul S,L?nborg JT,et al.Usefulness of high sensitivity troponin T to predict long-term left ventricular dysfunction after ST-elevation myocardial infarction[J].Am J Cardiol,2020,134:8-13.DOI:10.1016/j.amjcard.2020.07.060.
• [13]Hochman JS,Sleeper LA,Webb JG,et al.Early revascularization in acute myocardial infarction complicated by cardiogenic shock.SHOCK Investigators.Should we emergently revascularize occluded coronaries for cardiogenic shock[J].N Engl J Med,1999,341(9):625-634.DOI:10.1056/NEJM199908263410901.
• [14]Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTS Guidelines on myocardial revascularization[J].Eur Heart J,2019,40(2):87-165.DOI:10.1093/eurheartj/ehy394.
• [15]El Nasasra A,Hochadel M,Zahn R,et al.Outcomes after left main percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock(from the German ALKK PCI registry)[J].Am J Cardiol,2023,197:77-83.DOI:10.1016/j.amjcard.2023.04.007.
• [16]Saito Y,Kobayashi Y.Complete revascularization in acute myocardial infarction:a clinical review[J].Cardiovasc Interv Ther,2023,38(2):177-186.DOI:10.1007/s12928-022-00907-6.
• [17]Thiele H,Akin I,Sandri M,et al.PCI strategies in patients with acute myocardial infarction and cardiogenic shock[J].N Engl J Med,2017,377(25):2419-2432.DOI:10.1056/NEJMoa1710261.
• [18] Choi KH,Yang JH,Park TK,et al.Culprit-only versus immediate multiyessel percutaneous coronary intervention in patients with acute myocardial infarction complicating advanced cardiogenic shock requiring venoarterial-extracorporeal membrane oxygenation[J].J Am Heart Assoc,2023,12(10):e029792.DOI:10.1161/JAHA.123.029792.
• [19]Lee.JM,Rhee TM,Kim HE,et al.Comparison of long-term clinical outcome between multivessel percutaneous coronary intervention versus infarct-related artery-only revascularization for patients with ST-segment-elevation myocardial infarction with cardiogenic shock[J].J Am Heart Assoc,2019,8(24):e013870.DOI:10.1161/JAHA.119.013870.
• [20]Lawton JS,Tamis-Holland JE,Bangalore S,et al.2021 ACC/AHA/SCAI guideline for coronary artery revascularization:a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines[J].Circulation,2022,145(3):e18-e114.DOI:10.1161/CIR.0000000000001038.
• [21] Henry TD,Tomey MI,Tamis-Holland JE,et al.Invasivemanagement of acute myocardial infarction complicated by cardiogenic shock:a scientific statement from the American Heart Association[J].Circulation,2021,143(15):e815-e829.DOI:10.1161/CIR.0000000000000959.
• [22]Jin C,Yandrapalli S,Yang Y,et al.A comparison of inhospital outcomes between the use of impella and IABP in acute myocardial infarction cardiogenic shock undergoing percutaneous coronary intervention[J].J Invasive Cardiol,2022,34(2):E98-E103.
• [23]Thiele H,Zeymer U,Neumann FJ,et al.Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock(IABP-SHOCKⅡ):final 12 month results of a randomised,open-label trial[J].Lancet,2013,382(9905):1638-1645.DOI:10.1016/S0140-6736(13)61783-3.
• [24]Ibanez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2018,39(2):119-177.DOI:10.1093/eurheartj/ehx393.
• [25] Al-Atta A,Zaidan M,Abdalwahab A,et al.Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock[J].Rev Cardiovasc Med,2022,23(2):71.DOI:10.31083/j.rcm2302071.
• [26] van den Brink FS,Zivelonghi C,Vossenberg TN,et al.VAECMO with IABP is associated with better outcome than VAECMO alone in the treatment of cardiogenic shock in ST-elevation myocardial infarction[J].J Invasive Cardiol,2021,33(5):E387-E392.
• [27]Russo JJ,Aleksova N,Pitcher I,et al.Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock[J].J Am Coll Cardiol,2019,73(6):654-662,DOI:10.1016/j.jacc.2018.10.085.
• [28]廉坤,谢炜巍,陈根锐,等.体外膜肺氧合联合主动脉内球囊反搏辅助下行择期经皮冠状动脉介入治疗对复杂高危冠心病的中期疗效[J].中国介入心脏病学杂志,2021,29(7):380-385.DOI:10.3969/j.issn.1004-8812.2021.07.004.